Endoscopic suturing device

ABSTRACT

An endoscopic suturing device includes an endoscope, a curved needle detachably arranged at the distal end portion of or integrally embedded in the endoscope for suturing a tissue of the living body, a suture for suturing said tissue with the curved needle, and a drive arranged on the endoscope and operating the curved needle.

CROSS REFERENCE TO RELATED APPLICATIONS

[0001] This application claims priority to provisional applicationserial No. 60/236,365 filed Sep. 29, 2000.

FIELD OF THE INVENTION

[0002] The present invention relates to a suturing device used with anendoscope for suturing a tissue in a body cavity or stanching blood.

BACKGROUND OF THE INVENTION

[0003] Endoscopic suturing devices are known. One such device isdescribed, for example, in U.S. Pat. No. 5,037,433 to Peter J. Wilk.

[0004] Recently, developments in the endoscopic treatment procedure havebeen remarkable: medical treatment may be received without major surgeryin some cases such as an abdominal section. Since, suturing of tissueafter perforation in a body cavity or stanching of blood are veryimportant endoscopic techniques, efforts have been made to develop suchtechniques.

[0005] For example, U.S. Pat. No. 5,037,433 discloses a method in whichan elongate flexible outer tubular endoscope member comprises multipleflexible lumens, a flexible endoscope being arranged in one of saidlumens, an inner tubular member being arranged in another one of thelumens, and a forceps device with forceps in an elongate flexible bodyportion being arranged in a further one of the lumens. A curved needlecan be elastically transformed and inserted into the inner tube in astretched-straight state. Also the curved needle has a suture member onthe proximal end side. For suturing, the curved needle is pushed outfrom the inner tube by pushing the rod members, which are arranged topush out the curved needle, arranged on the distal end of the innertube. At the same time, the restoring force is utilized to suture awound in a body cavity.

[0006] Since the device disclosed in U.S. Pat. No. 5,037,433 uses anelastic curved needle inserted in a narrow inner tube in a stretchedstraight state. However, the curved needle cannot stick deeply into thetissue because the sticking force is reduced by resistance between theinner tube and the curved needle caused by the restoring power ofelasticity of the curved needle when the curved needle is pushed outfrom the inner tube by the rod member.

[0007] In addition, the flexible outer tubular endoscope member cannotbe bent sufficiently because the rod member has a certain rigidity topush out the curved needle from the inner tube. Further, since thecurved needle cannot be backed into the inner tube once the curvedneedle is stuck into the tissue, adjustment cannot be made when thecurved needle slips off the target. Moreover, a greater diameter of theflexible outer tubular endoscope member due to its multi-lumen structureincluding an endoscope, suturing member, and forceps device may increasethe pain of the patient. Furthermore, the separation structure of theendoscope and suturing device may decrease the manipulability.

SUMMARY OF THE INVENTION

[0008] By solving the above-mentioned problems, the present invention isintended to provide an endoscopic suturing device in which the stickingforce can be efficiently transmitted to the curved needle at any angleof the endoscope, the sticking location can be corrected several times,the outer diameter of the entire body can be smaller, the manipulabilityof endoscope and suturing device can be improved, and the targetlocation can be easily approached with the operating angle of theendoscope.

[0009] This is done with an endoscopic suturing device comprising anendoscope, a curved needle detachably arranged at the distal end portionof or integrally embedded in the endoscope for suturing a tissue of theliving body, a suture for suturing the tissue with the curved needle,and a driving means arranged on the endoscope and operating the curvedneedle.

[0010] The suturing device, detachably or integrally attached to the endof the endoscope, has a curved needle detachably or integrally attachedto the driving member. The curved needle has a perforation through whicha suture can pass: the suture passing through a channel of the endoscopefrom the proximal end to the distal end passes through the perforation.

[0011] The endoscope, at the distal end of which the suturing devicewith the curved needle contained in the protective member is mounted, isintroduced to a suturing target in a human being or animal body cavity.The curved needle is moved to the target region by manipulating thecontrol section arranged on the proximal side of the endoscope forcontrolling the curved needle, and the suturing device is pressed on theregion to be sutured, for example, by angling the endoscope. While thesuturing device is being pressed on the region, the curved needle isstuck into the tissue by manipulating its control section.

[0012] After sticking into the tissue, the tip of the needle and thesuture are confirmed on the surface of the tissue in the field of viewof the endoscope, an end of the suture is grasped with the graspingmember and brought to the proximal side with the grasping member. Thecurved needle is returned with the suture grasped on the proximal sideof the endoscope, and the curved needle is stuck into another regionnear the already stuck location. Then, another end of the suture isgrasped with the grasping member and brought to the proximal side withthe grasping member.

[0013] A knot is made with the two obtained ends, and pushed forward tothe target region through a channel of the endoscope by the knotpressure. By repeating the above-mentioned process several times, thetissue can be sutured.

BRIEF DESCRIPTION OF THE DRAWINGS

[0014]FIG. 1 is a view showing the general construction of an endoscopicsuturing device attached to the distal end of an endoscope according tothe present invention.

[0015]FIG. 2 is a sectional view taken along the line A-A of FIG. 1.

[0016]FIG. 3 is a detailed view of a curved needle.

[0017]FIGS. 4 through 13 show the suturing process of the firstembodiment 1.

[0018]FIG. 14 is a view for the endoscopic suturing device 1 whosedistal end portion is modified.

[0019]FIG. 15 is a sectional view taken along the line B-B of FIG. 14.

[0020]FIG. 16 is a detailed view of the curved needle 2.

[0021]FIG. 17 illustrates a possible configuration of the curved needle.

[0022]FIG. 18 illustrates a construction utilizing elastic deformationand claws.

[0023]FIG. 19 is a view of the endoscopic suturing device 1 whose distalend portion is modified.

[0024]FIG. 20 is a sectional view taken along the line C-C of FIG. 19.

[0025]FIG. 21 is a different composition of the curved needle 2″.

DETAILED DESCRIPTION

[0026] A first embodiment of the present invention is shown in FIGS. 1through 13. As shown in FIGS. 1 and 2, the endoscope 27 has a CCD camera22, light-guide 23, and forceps channel 24 in its distal end portion,while an up-down handle 12 and a right-left handle 13 for controllingthe tip bending section of the endoscope 27, a suction button 17, anair/water-supply button 16, an image pickup button 18, a shutter button20, an image enlarging button 19, an air/water-supply tube, light guide,suction tube, a channel opening 15, a universal cord 14 containingvarious cords for photographing and a curved needle driving mechanismfixation section 29 on its proximal side. In the present embodiment, avideoscope with a CCD is used, but a fiberscope with eyepieces may beused.

[0027] At the distal end of the endoscope 27, a protective member 5 isdetachably or integrally attached with a bolt 9 so that the curvedneedle 2 does not injure the human body when the device 1 is insertedinto a body cavity, and a slit 21 is arranged so that the curved needle2 can rotate. An axle 6 is fixed on the protective member 5 that isalmost orthogonal to the longitudinal axis of the endoscope 27. Arotation disk 3 is rotatably arranged around the axle 6, and a stopmember 30 like a C-ring is arranged so that the rotation disc cannotmove on the axle 6 in the axial direction. The curved needle 2 isdetachably or integrally attached to the rotation disk 3 via an arm 25,and, as shown FIGS. 1 and 2, the operating wire 4 for rotating therotation disk is interlinked at least with part of the rotation disk 3by brazing, soldering, or friction so that the power of the operatingwire 4 can be positively transmitted without slippage. On the proximalside, the two ends of the operating wire 4 are separately fixed tocurved needle control sections 31 and 32: the curved needle 2 can bemanipulated by alternately pushing and pulling the control sections 31and 32. It is needless to say that the curved needle can be rotatedforward and backward by manipulating the control sections 31 and 32.

[0028] On the other hand, as shown in FIG. 3, a small hole 26 throughwhich a suture 7 can pass is arranged on the sharp-edged end side of thecurved needle 2, and, as shown FIGS. 1 and 2, the suture 7 passesthrough the hole 26. As shown in FIG. 1, the proximal end portion of thesuture 7 is removed from the body cavity through the channel opening 15via the forceps channel 24.

[0029] A suture grasping/withdrawing means 8 is detachably arrangedinside the endoscopic suturing device 1 to grasp one end of the suture7, and withdraw it from the body, after the curved needle 2 is stuckinto a tissue. Although the grasping forceps is used in the presentembodiment, any appropriate tool may be used for the above-mentionedgrasping and withdrawing operation. The suture grasping/withdrawingmeans 8 are situated at an appropriate location so as to grasp one endof the suture 7 in an easy manner. The suture 7 passes through theforceps channel 24 like the suture grasping/withdrawing means 8. Aslider 33 is attached to the suture grasping control section 10: thegrasping member 34 arranged on the distal end can be opened or closed tograsp the suture 7 by pushing or pulling the slider 33.

[0030] With reference to FIGS. 1 through 3, the manner of assembling thefirst embodiment 1 will be described. While the suturing unit 36comprising a curved needle 2, rotation disk 3, operating wire 4,protective member 5, and axle 6 remains detached from the endoscope, thesuture 7 is passed through the hole 26. The suture grasping/withdrawingmeans 8 is inserted into the channel opening 15, and, as shown FIG. 1,one end of the suture 7, grasped by the suture grasping/withdrawingmeans 8, is taken out from the channel opening 15.

[0031] Next, the two ends of the operating wire 4 are grasped by thesuture grasping/withdrawing means 8 inserted from the curved needledriving mechanism fixation section 29, and brought on the proximal sideof the endoscope 27. Next, the suturing unit 36 is fixed to the distalend of the endoscope 27 with a bolt 9.

[0032] Next, the suture grasping/withdrawing means 8 is inserted intothe forceps channel 24, like the suture 7, until it is in such aposition as it can grasp the suture 7 after the needle is stuck into atissue. The suture grasping/withdrawing means 8 may be inserted when thesuture 7 is grasped and withdrawn after sticking.

[0033] Next, the suturing process will be described with reference toFIGS. 4 through 13.

[0034] (1.) The distal end of the endoscopic suturing device 1 isinserted into the body cavity for the region to be sutured.

[0035] (2.) The curved needle 2 is brought to the location shown in FIG.4 by backwardly rotating the rotation disk 3 by pulling on the curvedneedle control section 31.

[0036] (3.) After the curved needle 2 is stuck into the region to besutured in an almost transverse way, as shown in FIG. 5, by forwardlyrotating the rotation disk 3 by pulling the curved needle controlsection 32, one end of the suture 7 that is out of the tissue is graspedby the suture grasping/withdrawing means 8 inserted from the forcepschannel 24, and brought out from the body cavity as shown in FIG. 6.

[0037] (4.) As shown in FIG. 7, the curved needle 2 is rotated in thebackward direction, and then removed from the tissue once.

[0038] (5.) As shown in FIG. 8, the needle is stuck onto some location alittle bit away from the above-mentioned sutured point by angling thescope, and, as shown in FIGS. 9 through 11, another end of the suture 7is brought out from the body cavity without pulling the portion used forsuturing.

[0039] (6.) As shown in FIG. 12, the curved needle 2 is pulled from thetissue once again.

[0040] (7.) As shown in FIG. 13, the two end portions of the suture 7brought out from the body cavity are knotted, and the knot is pushed tothe sutured region through the forceps channel 24 by the knot pusher 35.The suturing process is completed after repeating this procedure severaltimes so as not to loosen the knot.

[0041] This embodiment has a number of merits. Since the sticking forcecan be efficiently transmitted to the curved needle for any bendingstate of the endoscope, the needle can be deeply stuck into the tissue.In addition, the suturing device can be inserted into a narrow bodycavity because the general outer diameter can be reduced, and themanipulability of the endoscope is improved and suturing procedure iseasier because the suturing device is integrally arranged on theendoscope.

[0042] A second embodiment is shown in FIGS. 14 through 18. Since theproximal side of the endoscopic suturing device 1 of this embodiment hasthe same construction as that of the first embodiment, a description isomitted. As in the first embodiment, a CCD camera 22, light guide 23,and forceps channel 24 are arranged in the distal end of the endoscope27.

[0043] As shown in FIGS. 1 and 14, a protective member 46 is detachablyor integrally attached to the distal end of the endoscope 27 with a bolt9 so that the curved needle 2 cannot injure the human body when theendoscopic suturing device 1 is inserted into a body cavity, and a slit42 is arranged so that the curved needle 2 can be rotated. Theprotective member is almost circular, and has a diameter almost equal tothe outer diameter of said endoscope.

[0044] If the protective member 46 is detachably attached to the distalend of the endoscope 27, any attachment means may be used. For example,as shown in FIG. 18, a construction utilizing elastic deformation andclaws may be employed. An axle 38 almost in parallel with thelongitudinal axis of the endoscope 27 is rotatably arranged in theprotective member 46. On the axle 38, the curved needle 2 is fixed at anappropriate location via an arm section 45 by brazing or some othermeans, while a bevel gear 39 is also fixed on the proximal side bybrazing or some other means. The axle section 38 between the curvedneedle 2 and bevel gear 39 is fit into the hole 47 arranged on theprotective member 46, and a stop member 44 like a C-ring is arranged onthe both sides of the hole 47 so that the axle 38 cannot come off in theaxial direction. The curved needle 2 may be configured as shown in FIG.17: a fitting section 51 is arranged on the proximal side of the curvedneedle 2. A slit 52, perforation 49, and female sutured hole 50 arearranged on the arm section 45. The fitting section 51 is fit into theslit 52, and fixed with a bolt 48; and if the bolt 48 is removed, thecurved needle 2 can be detached from the arm section 45 (forming adetachable structure).

[0045] The rotation disk 37, on which a bevel gear 40 is fixed as shownin FIG. 14, has a rotation axle 43, and is fit into the hole 53 arrangednear the distal end of the endoscope 27. The C-ring 41 is arranged sothat the rotation axle 43 cannot come out from the hole 53. As in thefirst embodiment, the operating wire 4 for rotating the rotation disk 37is interlinked at least with part of the rotation disk 37 by brazing,soldering, or friction so that the power of the operating wire 4 can bepositively transmitted without slippage.

[0046] Also as in the first embodiment on the proximal side, the twoends of the operating wire 4 are separately fixed to curved needlecontrol sections 31 and 32. The curved needle 2 can be manipulated byalternately pushing and pulling the control sections 31 and 32. It isneedless to say that the curved needle can be rotated forward andbackward by manipulating the control sections 31 and 32. In such a way,the power transmission means 54 comprising the bevel gears 39 and 40allows transmission of the power between the endoscope 27, and thesuturing unit 36 comprising the curved needle 2 axle section 38, bevelgear 39, stop member 44, and protective member 46, while at the sametime allowing the suturing unit 36 to be detachable. It is needless tosay that the suturing unit 36 can remain fixed to the endoscope 27 ifthe detachable structure is unnecessary. In addition, although the powertransmission means 54 is realized by bevel gears like 39 and 40, anyother means which result in power transmission, while still allowing thesuturing unit to be detachable from the endoscope 27 may be used. Forexample, a structure in which a motor is arranged on the side of unit36, and electric contact between unit 36 and endoscope 27 is providedcan be used.

[0047] On the other hand, as shown in FIG. 16, a small hole 26 throughwhich a suture 7 can pass is arranged on the sharp-edged end side of thecurved needle 2 and, as shown FIGS. 14 and 15, the suture 7 passesthrough the hole 26. As shown in FIG. 1 for the first embodiment, theproximal end portion of the suture 7 is removed from the body cavityfrom the channel opening 15 via the forceps channel 24.

[0048] As in the first embodiment, a suture grasping/withdrawing means 8is detachably arranged inside the endoscopic suturing device 1 to graspone end of the suture 7, and withdraw it from the body, after the curvedneedle 2 is stuck into a tissue. Although grasping forceps are used onthe present embodiment as in the first embodiment, any appropriate toolmay be used for the above-mentioned grasping and withdrawing operation.The suture grasping/withdrawing means 8 is situated at an appropriatelocation so as to grasp one end of the suture 7 in an easy manner. Thesuture 7 passes through the forceps channel 24 like the suturegrasping/withdrawing means 8 A slider 33 is attached to the suturegrasping control section 10: the grasping member 34 arranged on thedistal end can be opened or closed to grasp the suture 7 by pushing orpulling the slider 33.

[0049] With reference to FIGS. 1, 14, and 15, the manner of assemblingthe second embodiment will be described. While the suturing unit 36comprising a curved needle 2, axle 38, bevel gear 39, stop member 44,and protective member 46 remains detached from the endoscope 27, thesuture 7 is pushed through the hole 26. The suture grasping/withdrawingmeans 8 is inserted from the channel opening 15, and, as shown in FIG.1, one end of the suture 7 grasped by the suture grasping/withdrawingmeans 8 is taken out from the channel opening 15.

[0050] Next, the suturing unit 36 is fixed to the distal end of theendoscope 27 with a bolt 9″. Next, the suture grasping/withdrawing means8 is inserted into the forceps channel 24 like the suture 7 until insuch a position that it can grasp the suture 7 after the needle is stuckinto a tissue. The suture grasping/withdrawing means 8 may be insertedwhen the suture 7 is grasped and withdrawn after sticking.

[0051] The suturing process is the same as in the first embodiment.

[0052] In addition to those merits listed for the first embodiment,several addition advantages are present in the second embodiment. Sincethe power transmission allows the suturing unit to be detached, theendoscope 27 and suturing unit 36 can be cleaned more appropriately; thesuturing unit 36 can be a disposable component, or autoclaved; and theshape of protective member 46 or a slit 42 can be easily modified,

[0053] A third embodiment of the present invention is shown in FIGS.19-21. Again, since the proximal side of the endoscopic suturing device1 has the same construction as that of the first embodiment, descriptionis omitted. As in the first embodiment, a CCD camera 22, light guide 23,and forceps channel 24 are arranged in the distal end of the endoscope27.

[0054] As shown in FIG. 19, a protective member 58 is detachably orintegrally attached with a bolt 9″ to the distal end of the endoscope 27so that the curved needle 2″ does not injure the human body when theendoscopic suturing device 1 is inserted into a body cavity, and a slit59 is arranged so that the curved needle 2″ can be rotated.

[0055] An axle 6′ is fixed on the protective member 58 that is almostorthogonal to the longitudinal axle of the endoscope 27. The axle 6′ isfit into the hole 55 of the curved needle 2″, so that the curved needle2″ can be rotated. A stop member 30 like a C-ring is arranged so thatthe curved needle 2″ cannot move on the axle 6′ in the axial direction.

[0056] As shown in FIG. 19, the curved needle 2″ is interlinked byoperating wires 4′ and 4″ by brazing, soldering. Also, as shown in FIG.21, the operating wires 4′ and 4″ are passed through the holes 56 and 57of the curved needle by forming loops and fixed by blazing or soldering.On the proximal side, the two ends of the operating wires 4′ an 4″ arefixed to curved needle control sections 31 and 32 separately: the curvedneedle 2″ can be manipulated by the control sections 31 and 32.

[0057] Other parts are the same as in the embodiment 1.

[0058] Assembling of the third embodiment is described in FIG. 19 andFIG. 20. While the suturing unit 36″ comprising a curved needle 2″,operating wires 4″ and 4″, a protective member 58 and an axle 6′ isdetached from the endoscope 27, the suture 7″ is passed through the hole26″. The suture grasping/withdrawing means 8″ is inserted from thechannel opening 15, and as shown in FIG. 19, one end of the suture 7″grasped by the suture grasping/withdrawing means 8″ is taken out fromthe channel opening 15.

[0059] Next, both ends of the operating wires 4′ and 4″ are grasped bythe suture grasping/withdrawing means 8″ and inserted from the curvedneedle driving mechanism fixation sections 29, and brought to theproximal side of the endoscope 27. Next, the suturing unit 36″ is fixedto the distal end of the endoscope 27 with a bolt 9″.

[0060] Then, the suture grasping/withdrawing means 8″ is inserted intothe forceps channel 24, like the suture 7″, until such a position as cangrasp the suture 7″ after the needle is stuck into a tissue. The suturegrasping/withdrawing means 8″ may be inserted when the suture 7″ isgrasped and withdrawn after sticking.

[0061] The suturing process is the same as in the embodiment 1.

[0062] In addition to the merits listed for the first embodiment, inthis third embodiment, the sticking force can be increased by theprinciple of leverage, due to the operating wires 4′ and 4″ fixed at adistance from the axle 6″.

[0063] In all of the above embodiments, after the suture 7 is passedthrough the tissue, a knot is tied in the following manners:

[0064] For example, the distal end of the suture 7 is grasped by clampforceps or the like and is withdrawn toward the proximal side through achannel provided within or along the periphery of the endoscope. Thenthe suture 7 is knotted, and the knot is moved by a pusher tube or thelike toward the distal end of the endoscope through the channel to bindthe tissue by the suture 7. Tying the knot may be repeated severaltimes.

[0065] Instead of tying a knot, the suture 7 withdrawn toward theproximal side may be passed through a tube of rubber, and the tube ofrubber is moved toward the distal end of the endoscope to bind thetissue. The tube of rubber may be replaced with a clip.

[0066] Further, clamp forceps may be inserted into the channel of theendoscope toward its distal end to tie a knot there to bind the tissue.

[0067] In each of the above manners, after the tissue has been bound,suture cutting forceps are inserted into the channel of the endoscopetoward its distal end to cut a remaining part of the suture 7 whileobserving with the endoscope.

[0068] In summary, embodiments of the present invention have variousadvantages including:

[0069] (1.) The sticking force can be efficiently transmitted to thecurved needle even though the endoscope is in any state of bending.

[0070] (2.) Since the suturing device is integrated with the endoscope,the general outer diameter can be reduced, and it can be inserted into anarrow body cavity.

[0071] (3.) Since the suturing device is integrated with the endoscope,it can be brought to the target region only by manipulating theendoscope.

[0072] (4.) Since the control section of suturing device is arrangednear the control section of endoscope, the manipulability of thesuturing device and the endoscope can be improved.

[0073] (5.) The curved needle can be inserted to the target regionwithout injuring the body cavity.

[0074] (6.) The sticking location can be corrected.

[0075] (7.) The curved needle is detachable, and only the needle can bedisposable.

[0076] (8.) Since the suturing unit is detachable, only the suturingunit can be disposable, and the endoscope can be cleaned more easily.

[0077] (9.) Since the suturing unit is detachable, only the suturingunit can be sterilized, for example, by autoclave.

[0078] (10.) Since the needle is curved, the depth of sticking can bechanged by changing the curvature radius of needle.

[0079] (11.) Since the needle is curved, where the needle is stuck intoa tissue, or removed from the tissue is confirmed through the field ofview of endoscope.

[0080] (12.) In the case of first embodiment, suturing can be made infront of and tangent to the direction of the field of view of endoscope.

What is claimed is:
 1. An endoscopic suturing device comprising: anendoscope, a curved needle detachably arranged at the distal end portionof or integrally embedded in said endoscope for suturing a tissue of theliving body, a suture for suturing said tissue with said curved needle,and a driving means arranged on said endoscope and operating said curvedneedle.
 2. An endoscopic suturing device of claim 1, wherein saidendoscope is a flexible endoscope.
 3. An endoscopic suturing device ofclaim 1, wherein said driving means can produce rotary motion of saidcurved needle.
 4. An endoscopic suturing device of claim 3, wherein saidrotary motion is controllable in the forward direction as well as in thebackward direction.
 5. An endoscopic suturing device of claim 1, whereinsaid curved needle has at least one perforation through which saidsuture can pass.
 6. An endoscopic suturing device of claim 5, whereinsaid perforation is arranged near the sharp-edged end portion of saidcurved needle.
 7. An endoscopic suturing device of claim 1, wherein aprotective member covering at least part of said curved needle isarranged at the distal end portion of said endoscope.
 8. An endoscopicsuturing device of claim 7, wherein said protective member is almostcircular.
 9. An endoscopic suturing device of claim 7, wherein saidprotective member is almost circular and has a diameter almost equal tothe outer diameter of said endoscope.
 10. An endoscopic suturing deviceof claim 1, wherein said driving means comprises at least one wire. 11.An endoscopic suturing device of claims 1, wherein the rotation axis ofsaid curved needle is substantially orthogonal to the longitudinal axisof said endoscope.
 12. An endoscopic suturing device of claim 1, whereinthe rotation axis of said curved needle is substantially parallel to thelongitudinal axis of said endoscope.
 13. An endoscopic suturing deviceof claim 1, wherein an axle member constituting the rotational axis ofsaid curved needle and an arm member coupling said axle member and saidcurved needle are arranged.
 14. An endoscopic suturing device of claim1, wherein at least one wire is wound or fixed on at least a cylindricalmember which is part of the rotation axis of said curved needle.
 15. Anendoscopic suturing device of claim 1, wherein the center of curvatureof said curved needle is not coincident with the center of the rotationaxis of said curved needle.
 16. An endoscopic suturing device of Claim1, wherein the axle member of said curved needle is fixed to theprotective member covering at least part of said curved needle.
 17. Anendoscopic suturing device of claim 1, wherein a grasping me member thatcan grasp said suture is arranged on the distal end portion of saidendoscopic suturing device.
 18. An endoscopic suturing device of claim1, wherein the operation means of said driving means is arranged on theproximal end side of said endoscope.
 19. An endoscopic suturing deviceof claim 1, wherein a suturing unit comprising at least said curvedneedle, the rotation axis of said curved needle, and the protectivemember covering at least part of said curved needle is detachablyarranged on the distal end portion of said endoscope.
 20. An endoscopicsuturing device of claim 19, wherein said driving means is arrangedseparable between said suturing unit and said endoscope.
 21. Anendoscopic suturing device of claim 1, wherein said driving meanscomprises at least two bevel gears.